Alcohol as a Cardiovascular Trigger

Mar 07, 2016
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Authors:
Mostofsky E, Chahal HS, Mukamal KJ, Rimm EB, Mittleman MA.
Citation:
Alcohol and Immediate Risk of Cardiovascular Events: A Systematic Review and Dose-Response Meta-Analysis. Circulation 2016;Mar 2:[Epub ahead of print].
Summary By:
Elizabeth A. Jackson, MD, FACC

Study Questions:

Does alcohol intake have an immediate effect on cardiovascular risk?

Methods:

Manuscripts included in this systematic review/meta-analysis were identified through a literature search of CINAHL, Embase, PubMed, and PsycINFO from inception to March 12, 2015. A supplemental manual screening for observational studies was also performed. All studies that reported on the association of alcohol intake and cardiovascular events within the following hours and days were included. The primary outcomes of interest were myocardial infarction (MI), ischemic stroke (IS), and hemorrhagic stroke (HS).

Results:

Of the 1,056 citations and 37 full-text articles identified and reviewed, 23 studies were included, totaling 29,457 participants. Moderate alcohol consumption was associated with an immediately higher cardiovascular risk, which declined over the following 24 hours after alcohol intake. Moderate alcohol intake was protective after 24 hours (defined as ~2-4 drinks: relative risk [RR] = 30% lower risk) for MI and HS and protective against IS within 1 week (~6 drinks: 19% lower risk). However, heavy alcohol drinking was associated with increased cardiovascular risk in the following day (~6 drinks: RR = 1.3-2.3) and following week (~19-30 drinks: RR = 2.25-6.2).

Conclusions:

The investigators concluded that an immediately higher cardiovascular risk following any alcohol consumption was reduced in the following 24 hours; however, heavy alcohol intake was associated with continued risk for cardiovascular events.

Perspective:

This systematic review/meta-analysis provides clinically useful information on the risks (and benefits) of alcohol intake in association with cardiovascular risks. Additional factors for clinicians to include in discussions with patients would be potential for differences between men and women in the associations described above. Further analysis related to potential gender differences is warranted. Furthermore, interactions between medicines patients are taking and alcohol must be considered.

Keywords: Alcohol Drinking, Intracranial Hemorrhages, Myocardial Infarction, Primary Prevention, Risk Factors, Stroke


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